Inflammatory Bowel Disease - IBD

What is inflammatory bowel disease (IBD)?

Inflammatory bowel disease – commonly called IBD – is a non-contagious (non-infectious) condition where the small or large intestines become inflamed. It is often confused with irritable bowel syndrome but they are two different conditions.

IBD is more common than most people realize. Over 200,000 Canadians suffer from the disease. An estimated 25% of IBD cases in Ontario are under the age of 18 and increasingly, it’s becoming more common in children.

There are two main subtypes of IBD, Crohn’s disease (CD) and Ulcerative colitis (UC), which may have similar symptoms but may also have some differences between them. It can be hard to diagnose whether the IBD condition is CD or UC. Even though your doctor knows you have IBD, it can be very difficult to determine the exact type in the beginning.

Both CD and UC cause inflammation of the bowels. But CD may cause inflammation anywhere along the digestive tract from the mouth to the end of the bowel while UC is found only in the large intestine (colon). Many of the treatments can be the same for both CD and UC but there can be variations according to the specifics of each person’s condition.

Common Symptoms of IBD

The symptoms of IBD can be intense at times, but rarely disappear into remission without treatment. There are no treatments to cure IBD but there are a number of medications to try to control the inflammation to help heal the bowel and relieve the symptoms. Sometimes the remission provided by medications wears off, leading to the return of inflammation and symptoms. Sometimes surgery is required when medications do not control the inflammation of the lining of the bowels or when complications occur. Symptoms of IBD are different for each child but may include:

Diarrhea or frequent loose bowel movements

Blood in bowel movements

Abdominal pain

Bloating

Lack of appetite

Poor weight gain or even weight loss

Fatigue

Fever

Joint pain

Skin problems

Stunted growth

Causes

The precise cause of IBD is unknown but research suggests a predisposition to its development is inherited through any number of genes that make a child more susceptible. Even though someone may be predisposed to developing a condition, there is also the belief that something must trigger IBD’s development.

There is a lot of research focused on learning what these triggers are. Perhaps, there is something in the environment. Or, something gets into the intestinal tract close to the lining of where the body’s own protective immune cells attack their own gastrointestinal tissue, causing swelling and inflammation.

Although perceived stress is important to acknowledge for its role in the severity of symptoms, IBD is not caused by stress or eating certain foods.

Diagnosis

CHEO has experienced a 69% increase in the last several years in IBD out-patient clinic visits. Part of the reason for this increase lies in the increased awareness of IBD and improved diagnostic techniques. But the increase isn’t all due to improved diagnosis and detecting IBD at an earlier age. In landmark research that CHEO was involved in, analysis of Ontario government and hospital data showed there are more children being diagnosed with IBD now than 10 years ago and this increase is in younger children.

When symptoms suggest a child might be suffering from IBD, several types of tests need to be done to be sure of the diagnosis including blood tests, stool cultures or endoscopy, which examines the insides of the bowel.

CHEO also uses a new technique called capsule endoscopy which can provide views of bowel regions that endoscopes can’t reach. CHEO also has developed techniques to image the bowel that do not require X-ray radiation.

Treatment

Treatments for IBD vary depending on whether it is Crohn’s disease or ulcerative colitis. It also varies according to the severity of the disease and the site of the intestinal tract involved. Your IBD doctor at CHEO has a thorough understanding of all these aspects and will discuss the best treatment option with you and your child.

The good news is that most children live normal, healthy lives once the appropriate treatment plan has been identified. These plans typically involve medication and nutritional recommendations. There have been claims that special diets alone can control IBD but none have been proven effective over the long haul.

CHEO has an interdisciplinary team of specialists trained in the most current IBD treatments including physicians, nurses, dieticians, social workers, surgeons, radiologists. We also involve other pediatric specialists as required.

In addition to teaching the next generation of care providers, the CHEO IBD team is very actively involved in studying and conducting research on many aspects of the disease including diagnostics, its causes and treatments.